*Update from NHS England 30 November 2017*
NHS England's Board has endorsed a proposal regarding the commissioning of congenital heart disease (CHD) services in England.
Read our response to the decision from Bob Bell, Royal Brompton & Harefield NHS Foundation Trust chief executive.
NHS England plans to decommission congenital heart disease (CHD) services at Royal Brompton would have a range of implications for other services offered by the Trust.
Dismantling expert teams
Losing congenital heart services would mean the break-up of well-established and skilled multi-disciplinary teams: it would also represent a substantial body blow to national and international clinical and translational research programmes.
Patient care depends upon a myriad of partnerships. Surgeons need the highly expert team of anaesthetists, perfusionists, nurses and others who look after the patient in theatre. Patients also depend upon the cardiologists and investigative specialists who work up the case before they go to theatre, as well as the team that takes over at the conclusion of the operation and manages them safely through intensive care.
Ward staff oversee the next stage of their stay, supported by physiotherapy teams and other allied health professionals. Up to 100 people will look after one patient and an optimal outcome depends upon them all playing their part. The transfer of that entire team to another centre is highly unlikely to be achieved, even if the extra resources that would be needed were available.
Disrupting a team that has been assembled over decades, involves certain disadvantage and uncertain benefit.
In the face of this proposed disruption, the onus must be on those planning change to justify their proposals. Before successful teams are dismantled, it must be possible to describe the alternative and to demonstrate how and why it will be an improvement.
Paediatric intensive care and anaesthesia
Decommissioning congenital cardiac services from Royal Brompton would mean the paediatric intensive care unit (PICU) would inevitably close; without the children’s heart surgery element there would not be enough activity to safely maintain it. This would, at a stroke, reduce the number of PICU beds in London by 20%.
In addition to the loss of PICU, there would be the loss of specialist paediatric anaesthesia from the site. ‘Occasional’ anaesthesia practice is not safe and our paediatric anaesthetists would not be exposed to enough cases to meet professional standards. Many of our highly specialist paediatric anaesthetists care for adults and children, and may choose to stay at Royal Brompton. Their skills would therefore be lost to children’s cardiac services completely.
Paediatric respiratory medicine
Royal Brompton Hospital is home to the largest cystic fibrosis service in the country. Teams at Royal Brompton treat babies and children from around the country with some of the most severe forms of cystic fibrosis, asthma, the muscular dystrophies and other respiratory illnesses. Without the back-up of intensive care and on-site anaesthesia, Royal Brompton clinicians would not be able to undertake the more complex specialist treatments they do now, because they consider it unsafe to do so.
Royal Brompton’s respiratory teams also undertake ground breaking research into important areas such as cystic fibrosis, severe asthma, lung disease, inflammation of the airways and neuromuscular conditions. The research they undertake can only be carried out at a specialist hospital, where the combination of clinical expertise, the type of patients seen and the number of patients seen, provide the necessary conditions.
Without a children’s intensive care unit and on-site anaesthetists, Royal Brompton cannot offer the type of specialist respiratory care it does now and its respiratory consultants will seek work elsewhere. As a result, the expert teams that are responsible for both clinical care and research programmes would be broken up.
The assisted ventilation service would also become non-viable.